Provider Demographics
NPI:1801915871
Name:SHIVERS, MARLENE ZETZER (MD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:ZETZER
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARLENE
Other - Middle Name:JUDITH
Other - Last Name:ZETZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:267 N HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5341
Mailing Address - Country:US
Mailing Address - Phone:912-634-1753
Mailing Address - Fax:912-634-0959
Practice Address - Street 1:2415 PARKWOOD DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4722
Practice Address - Country:US
Practice Address - Phone:912-466-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry